POST TRAUMATIC STRESS DISORDER 1996

Amplifies Chronic Pain

Chronic pain and symptoms of PTSD commonly co-exist. Accident pain causes more disability than comparable nonaccident pain. On the basis of their data, the authors[1] propose that refractory accident pain should trigger an inquiry for symptoms of PTSD, that treatment of the Disorder may be necessary for the relief of Chronic Pain.

PRACTICE POINT

Evidence for co-existing Post Traumatic Stress Disorder should be considered when Chronic Pain is refractory to treatment


MTBI

Two case-studies from England contribute to the debate whether Mild Traumatic Brain Injury and PTSD are mutually exclusive (see Medical Litigation News Volume 2, Issue 8). According to the report[2] of one patient, exceptions to the "rule" may occur when antegrade and retrograde amnesia are minimal, or when memory is suppressed. In this case, a third model of "islands" of memory is proposed.

Another author[3], while acknowledging the rarity of the dual diagnosis, gives details of 10 cases, some with Severe Traumatic Brain Injury. He proposes similarly that "windows" of real or imagined experience during the amnesia may permit development of the disorder.

PRACTICE POINT

Traumatic Brain Injury and PTSD are generally mutually exclusive, but "windows" or "islands" of memory may explain the occasional exceptions


Children

PTSD may prove a misdiagnosis in childhood. When correctly diagnosed, there is commonly serious associated psychiatric illness, including suicidal risk[4]. Extensive testing and intensive multidisciplinary therapy are required.

Gender

There has been little research on gender differences. A study[5] two years after a non-fatal motor coach accident in the Austrian Alps involving adolescents showed the girls to be less well adjusted. Hospitalisation was similarly an adverse prognostic factor.

PRACTICE POINT

Childhood PTSD, sometimes difficult to diagnose, is often serious, disabling and warrants vigorous treatment


Treatment Effectiveness

German researchers have summarised the evidence for the effectiveness of various forms of treatment6. Behavioural therapy reduces intrusive symptoms in controlled trials. One study showed a reduction in avoidance symptoms following Psychodynamic therapy. Efficacy of Family and Group Therapies remains untested. Some antidepressant medications have proven benefit.

PRACTICE POINT

The efficacy of specific treatments for different aspects of PTSD is now better founded in empirical research


Hormones

Previous studies have shown a decreased production of the stress hormone Cortisone by the Adrenal gland in PTSD. Newly reported investigations[7] have elucidated the hormonal mechanism for this change.

PRACTICE POINT

Quantum of damages should take into account the increased vulnerability to future illness and physiological stress

Copyright 2008 Electronic Handbook of Legal Medicine